J Complement Integr Med. 2015; 12(2): 111–115
Review Yulia Treister-Goltzman* and Roni Peleg
Trends in publications on complementary and alternative medicine in the medical literature Introduction
Abstract Background: Public interest in and demand for complementary and alternative medicine (CAM) services have increased in recent years throughout the Western world. The aim of the study was to assess trends in publications on CAM in the medical literature between 1963 and 2012 and to compare them with overall trends in publications on medical issues. Methods: A search of the literature was conducted on CAM and integrative medicine using the PubMed and Google Scholar search engines with key search terms. Results: Articles on CAM began to appear in the medical literature 50 years ago. Over the years there has been an increase in the number of publications. On PubMed the increase was from 15,764 to 144,288 articles from 1963 to 2012. In the decade between 1963 and 1972 publications on CAM comprised 0.81 % of all the articles appearing in PubMed. Over the course of the 50 years, the percentage increased more than twofold to 1.92 % from 2003 to 2012. On Google Scholar there were 27,170 citations related to CAM between 1963 and 1972. This increased to 2,521,430 between 2003 and 2012. Conclusions: Over the last 50 years there has been an increase in scientific publications on CAM in general, and on specific CAM treatments in particular. Keywords: complementary and alternative medicine, Google Scholar, integrative medicine, PubMed DOI 10.1515/jcim-2014-0055 Received October 11, 2014; accepted November 30, 2014; previously published online January 7, 2015
*Corresponding author: Yulia Treister-Goltzman, Clalit Health Services, Southern District, Beer-Sheva, Israel; The Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Practice and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel, E-mail: [email protected] Roni Peleg, Clalit Health Services, Southern District, Beer-Sheva, Israel; The Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Practice and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
According to the US National Center for Complementary and Alternative Medicine (NCCAM), complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. Most of the population in developing countries cannot afford even elementary medical procedures, medications, and immunizations so they turn to traditional medicine. In developed countries the main health burden today involves cardiovascular disease, diabetes mellitus, hypertension, mental illness, smoking, and substance abuse. Since lifestyle, obesity, lack of physical exercise, and stress are important factors for these diseases, the CAM approach can be of great benefit in the development of healthcare strategies [1]. As medical and health information becomes more available to patients and as they become more involved in their treatment, many look for a more natural and holistic approach to health. The results of surveys on this issue showed an increase in the use of CAM in developed countries [2–6]. Interestingly, the most significant predictor of CAM use was a higher educational level [7]. It is difficult to compare CAM in various countries and cultures due to differences in the definition of CAM, differences in the quality of and methods used in various published studies, and differences in the time periods surveyed [8]. However, based on existing data, about 60 % of the populations of France, Germany, and the UK use homeopathic agents and medicinal herbs [9], about 40 % of adults in the United States [5], and about 12 % of Israelis [3] turn to various CAM treatment modalities. With the increased interest in and use of CAM and increasing evidence for its potential benefit in terms of cost-benefit and cost savings using certain CAM methods [10], a new branch of integrative medicine is developing in which there is a integrated use of conventional and CAM treatments [7, 11, 12]. On the other hand, it is noteworthy that in developed countries CAM is usually paid directly by the patient, and not covered by the national health insurance, at most partially covered by private insurances, so it may be cost saving for the government, not for the user.
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112
Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
Thus, it is logical that this increased interest in the use of CAM would lead to an increase in research and publication in the field and it is reciprocal: the increase in publications and publicity induces an increase in use. The aim of the present study was to evaluate trends in publications on CAM between 1963 and 2012 and to compare publication trends in all medical subjects over those years.
Materials and methods An Internet search was conducted on CAM in general and on the main CAM treatment methods in particular between the years 1963 and 2012 using the search engines PubMed and Google Scholar. The following search terms were used: complementary medicine, complementary and alternative medicine, alternative medicine, integrative medicine, manipulative medicine, osteopathic treatment, massage therapy, hypnotherapy, reflexology, herbal medicine, chiropractic, biofeedback, acupuncture, and homeopathy. The study time span was divided into 10-year periods and the number of publications per decade was determined. We compared the total number of citations on CAM in PubMed to the total overall number of publications for each time period.
Results According to the PubMed search, papers on CAM such as hypnosis, reflexology, and massage therapy began
Table 1
to appear as long ago as 50 years, although at that time they did not appear under the heading of CAM. Over the years there has been an increase in the number of articles published on subjects related to CAM. The absolute number of publications cited in PubMed, divided by decades, is shown in Table 1. In all, the number of citations increased over five decades from 15,764 to 144,288 (Figure 1(A)). There was a corresponding increase, over the same period of time, in the overall number of citations in PubMed (Table 1). From 1963 to 1972 CAM publications comprised 0.81 % of all publications cited in PubMed. This percentage increased over the years more than twofold to 1.92 % (Figure 1(B)). The search in Google Scholar also showed an increase in citations for CAM from 27,170 in 1963–1972 to 2,521,430 in 2003–2012 (Table 2). The increase by decades is shown in Figure 1(C).
Discussion PubMed is a free database that primarily accesses the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintains the database as part of the Enter system of information retrieved [13]. Google Scholar is a relatively new site that facilitates searches into the scholarly literature, including peerreview papers, theses, books, preprints, abstracts, and technical reports from a broad range of research areas.
Citations on CAM in PubMed, by decade and search term.
Search term Homeopathy Acupuncture Biofeedback Chiropractic Herbal medicine Reflexology Hypnotherapy Osteopathy Massage therapy Manipulative therapy Complementary medicine Integrative medicine Complementary alternative medicine Complementary integrative medicine Total All PubMed citations
1963–1972
1973–1982
1983–1992
1993–2002
2003–2012
333 254 2 139 6 1,717 2,474 73 1,714 39 9,011 2 0 0 15,764 1,939,646
340 2,163 1,499 295 117 1,135 2,585 84 1,129 125 17,992 16 0 1 27,481 2,629,530
450 3,103 1,784 942 1,096 1,289 2,183 383 1,285 519 23,464 149 0 1 36,648 3,676,052
1,201 3,334 1,695 1,738 4,260 2,081 1,879 766 2,055 956 47,262 833 25 125 68,210 4,796,029
1,881 9,744 3,851 2,414 14,750 4,043 2,470 1,336 3,996 1,509 89,465 5,318 2,658 853 144,288 7,503,980
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Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
113
Figure 1 (A) Number of PubMed citations on CAM, by decade. (B) CAM citations as a percentage of all PubMed citations (%). (C) Number of Google Scholar citations on CAM, by decade.
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114
Table 2
Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
Citations on CAM in Google Search, by decade and search term.
Search term Homeopathy Acupuncture Biofeedback Chiropractic Herbal medicine Reflexology Hypnotherapy Osteopathy Massage therapy Manipulative therapy Complementary medicine Integrative medicine Complementary alternative medicine Complementary integrative medicine Total
1963–1972
1973–1982
1983–1992
1993–2002
2003–2012
655 1,240 362 729 849 215 937 943 4,490 1,590 7,730 2,680 1,960 2,790 27,170
1,030 9,620 10,900 2,130 3,520 318 1,410 1,440 5,090 3,510 17,600 6,040 6,280 7,400 76,228
3,160 15,700 15,000 5,480 12,400 742 2,750 2,320 9,140 6,200 57,700 17,000 23,800 17,100 188,492
11,700 61,700 20,600 15,100 43,900 3,310 4,850 5,810 19,900 14,100 421,000 65,200 111,000 21,500 819,670
16,500 95,300 30,100 21,500 163,000 9,130 11,100 14,200 24,400 18,700 1,101,000 335,000 774,000 18,500 2,541,430
We chose to use these two recognized search engines to evaluate trends in publications on CAM over the last 50 years. We found a large, consistent increase in the number of publications related to CAM over this period of time. The number of citations in PubMed increased over these 50 years more than twofold to 1.92 % of all citations. We did not find any previous paper in the medical literature that presented similar data. The classic papers that drew the attention of conventional medicine to CAM were published about 20 years ago. In 1993 Eisenberg published the results of a nationwide telephone survey in the United States, which showed that 34 % of the participants had utilized CAM in the previous year and that a third had visited a CAM practitioner [14]. There is an enormous economic potential in the field of CAM. In 1990, US residents made about 425 million visits to these practitioners, compared with 338 million visits to primary care physicians over the same period. The total expenditure by US residents for CAM for that year was estimated to be 13.7 billion dollars [15]. Recently, the process in which some of the CAM modalities have moved from a marginal position to the mainstream of medicine has led to an integration of healthcare systems. This change is especially salient in developed countries. With increased demand for CAM, there has been a shift toward integration between conventional medicine and CAM [16]. Over the last 50 years there has been large increase in the number of medical publications on CAM in general as well as on specific treatment modalities. The number of publications on CAM has grown in parallel to its development as a treatment modality. Modalities
that were previously almost unknown such as homeopathy, herbal medicine, and acupuncture are now appearing increasingly in medical publications. In contrast, there were already articles on hypnosis 50 years or more ago. Axel Munthe describes this treatment modality in the book “The Story of San Michele.” Over the years no increase in publications on this treatment has been seen in PubMed. In this study we did not assess individual papers, so articles that are not actually related to CAM may have been picked up by the search terms that we used. However, this potential bias should be the same for all time periods evaluated so it should not affect the trend of changes in the number of publications over time. We also did not look at the content of the articles so that it is possible that some of them do not prove the effectiveness of CAM or even show it to be ineffective. Yet, we believe that the data presented in this paper will contribute to existing knowledge on CAM. The effectiveness of various treatment modalities should be assessed so that the quality of medical care can be enhanced. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Research funding: None declared. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
References 1. Debas HT, Laxminaryan R, Straus SE. Complementary and alternative medicine. In: Jamison DT, Breman JG, Measham AR, et al. editors. Disease control priorities in developing countries, 2nd ed. Washington, DC: World Bank, 2006:1281. 2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a followup national survey. JAMA 1998;280:1569–75. 3. Shmueli A, Shuval J. Use of complementary and alternative medicine in Israel: 2000 vs. 1993. IMAJ 2004;6:3–8. 4. Jonas WB, Eisenberg D, Hufford D, Crawford C. The evolution of complementary and alternative medicine (CAM) in the USA over the last 20 years. Forsch Komplementmed 2013;20:65–72. 5. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports 2008:1–23. 6. Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine and frequency of visits to CAM practitioners: US, 2007. 2009, National Center for Health Statistics, Hyattsville, MA. 7. Giordano J, Boatwright D, Stapleton S, Huff L. Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice. J Altern Complement Med 2002;8:897–906.
115
8. Turner L, Galipeau J, Garritty C, Manheimer E, Vieland LS, Yazdi F, et al. An evaluation of epidemiological and reporting characteristics of complementary and alternative medicine (CAM) systematic reviews (SRs). PLoS One 2013;8:e53536. 9. Ni H, Simile C, Hardy AM. Utilization of complementary and alternative medicine by United States adults: results from the 1999 national health interview survey. Med Care 2002;40:353–8. 10. Herman PM, Poindexter BL, Witt CM, Eisenberg DM. Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ Open 2012;2:e001046. 11. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore 2009;5:277–89. 12. Ryan TJ. Integrative medicine selects best practice from public health and biomedicine. Indian J Dermatol 2013;58:132–41. 13. Wikipedia. PubMed. http://en.wikipedia.org/wiki/PubMed. Accessed 10/2013. 14. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246–52. 15. Gavaghan H. Koop may set up new centre for alternative medicine. Nature 1994;370:591. 16. Jong MC, van de Vijver L, Busch M, Fritsma J, Seldenrijk R. Integration of complementary and alternative medicine in primary care: what do patients want? Patient Educ Couns 2012;89:417–22.
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Review Yulia Treister-Goltzman* and Roni Peleg
Trends in publications on complementary and alternative medicine in the medical literature Introduction
Abstract Background: Public interest in and demand for complementary and alternative medicine (CAM) services have increased in recent years throughout the Western world. The aim of the study was to assess trends in publications on CAM in the medical literature between 1963 and 2012 and to compare them with overall trends in publications on medical issues. Methods: A search of the literature was conducted on CAM and integrative medicine using the PubMed and Google Scholar search engines with key search terms. Results: Articles on CAM began to appear in the medical literature 50 years ago. Over the years there has been an increase in the number of publications. On PubMed the increase was from 15,764 to 144,288 articles from 1963 to 2012. In the decade between 1963 and 1972 publications on CAM comprised 0.81 % of all the articles appearing in PubMed. Over the course of the 50 years, the percentage increased more than twofold to 1.92 % from 2003 to 2012. On Google Scholar there were 27,170 citations related to CAM between 1963 and 1972. This increased to 2,521,430 between 2003 and 2012. Conclusions: Over the last 50 years there has been an increase in scientific publications on CAM in general, and on specific CAM treatments in particular. Keywords: complementary and alternative medicine, Google Scholar, integrative medicine, PubMed DOI 10.1515/jcim-2014-0055 Received October 11, 2014; accepted November 30, 2014; previously published online January 7, 2015
*Corresponding author: Yulia Treister-Goltzman, Clalit Health Services, Southern District, Beer-Sheva, Israel; The Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Practice and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel, E-mail: [email protected] Roni Peleg, Clalit Health Services, Southern District, Beer-Sheva, Israel; The Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Practice and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
According to the US National Center for Complementary and Alternative Medicine (NCCAM), complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. Most of the population in developing countries cannot afford even elementary medical procedures, medications, and immunizations so they turn to traditional medicine. In developed countries the main health burden today involves cardiovascular disease, diabetes mellitus, hypertension, mental illness, smoking, and substance abuse. Since lifestyle, obesity, lack of physical exercise, and stress are important factors for these diseases, the CAM approach can be of great benefit in the development of healthcare strategies [1]. As medical and health information becomes more available to patients and as they become more involved in their treatment, many look for a more natural and holistic approach to health. The results of surveys on this issue showed an increase in the use of CAM in developed countries [2–6]. Interestingly, the most significant predictor of CAM use was a higher educational level [7]. It is difficult to compare CAM in various countries and cultures due to differences in the definition of CAM, differences in the quality of and methods used in various published studies, and differences in the time periods surveyed [8]. However, based on existing data, about 60 % of the populations of France, Germany, and the UK use homeopathic agents and medicinal herbs [9], about 40 % of adults in the United States [5], and about 12 % of Israelis [3] turn to various CAM treatment modalities. With the increased interest in and use of CAM and increasing evidence for its potential benefit in terms of cost-benefit and cost savings using certain CAM methods [10], a new branch of integrative medicine is developing in which there is a integrated use of conventional and CAM treatments [7, 11, 12]. On the other hand, it is noteworthy that in developed countries CAM is usually paid directly by the patient, and not covered by the national health insurance, at most partially covered by private insurances, so it may be cost saving for the government, not for the user.
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112
Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
Thus, it is logical that this increased interest in the use of CAM would lead to an increase in research and publication in the field and it is reciprocal: the increase in publications and publicity induces an increase in use. The aim of the present study was to evaluate trends in publications on CAM between 1963 and 2012 and to compare publication trends in all medical subjects over those years.
Materials and methods An Internet search was conducted on CAM in general and on the main CAM treatment methods in particular between the years 1963 and 2012 using the search engines PubMed and Google Scholar. The following search terms were used: complementary medicine, complementary and alternative medicine, alternative medicine, integrative medicine, manipulative medicine, osteopathic treatment, massage therapy, hypnotherapy, reflexology, herbal medicine, chiropractic, biofeedback, acupuncture, and homeopathy. The study time span was divided into 10-year periods and the number of publications per decade was determined. We compared the total number of citations on CAM in PubMed to the total overall number of publications for each time period.
Results According to the PubMed search, papers on CAM such as hypnosis, reflexology, and massage therapy began
Table 1
to appear as long ago as 50 years, although at that time they did not appear under the heading of CAM. Over the years there has been an increase in the number of articles published on subjects related to CAM. The absolute number of publications cited in PubMed, divided by decades, is shown in Table 1. In all, the number of citations increased over five decades from 15,764 to 144,288 (Figure 1(A)). There was a corresponding increase, over the same period of time, in the overall number of citations in PubMed (Table 1). From 1963 to 1972 CAM publications comprised 0.81 % of all publications cited in PubMed. This percentage increased over the years more than twofold to 1.92 % (Figure 1(B)). The search in Google Scholar also showed an increase in citations for CAM from 27,170 in 1963–1972 to 2,521,430 in 2003–2012 (Table 2). The increase by decades is shown in Figure 1(C).
Discussion PubMed is a free database that primarily accesses the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintains the database as part of the Enter system of information retrieved [13]. Google Scholar is a relatively new site that facilitates searches into the scholarly literature, including peerreview papers, theses, books, preprints, abstracts, and technical reports from a broad range of research areas.
Citations on CAM in PubMed, by decade and search term.
Search term Homeopathy Acupuncture Biofeedback Chiropractic Herbal medicine Reflexology Hypnotherapy Osteopathy Massage therapy Manipulative therapy Complementary medicine Integrative medicine Complementary alternative medicine Complementary integrative medicine Total All PubMed citations
1963–1972
1973–1982
1983–1992
1993–2002
2003–2012
333 254 2 139 6 1,717 2,474 73 1,714 39 9,011 2 0 0 15,764 1,939,646
340 2,163 1,499 295 117 1,135 2,585 84 1,129 125 17,992 16 0 1 27,481 2,629,530
450 3,103 1,784 942 1,096 1,289 2,183 383 1,285 519 23,464 149 0 1 36,648 3,676,052
1,201 3,334 1,695 1,738 4,260 2,081 1,879 766 2,055 956 47,262 833 25 125 68,210 4,796,029
1,881 9,744 3,851 2,414 14,750 4,043 2,470 1,336 3,996 1,509 89,465 5,318 2,658 853 144,288 7,503,980
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Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
113
Figure 1 (A) Number of PubMed citations on CAM, by decade. (B) CAM citations as a percentage of all PubMed citations (%). (C) Number of Google Scholar citations on CAM, by decade.
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114
Table 2
Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
Citations on CAM in Google Search, by decade and search term.
Search term Homeopathy Acupuncture Biofeedback Chiropractic Herbal medicine Reflexology Hypnotherapy Osteopathy Massage therapy Manipulative therapy Complementary medicine Integrative medicine Complementary alternative medicine Complementary integrative medicine Total
1963–1972
1973–1982
1983–1992
1993–2002
2003–2012
655 1,240 362 729 849 215 937 943 4,490 1,590 7,730 2,680 1,960 2,790 27,170
1,030 9,620 10,900 2,130 3,520 318 1,410 1,440 5,090 3,510 17,600 6,040 6,280 7,400 76,228
3,160 15,700 15,000 5,480 12,400 742 2,750 2,320 9,140 6,200 57,700 17,000 23,800 17,100 188,492
11,700 61,700 20,600 15,100 43,900 3,310 4,850 5,810 19,900 14,100 421,000 65,200 111,000 21,500 819,670
16,500 95,300 30,100 21,500 163,000 9,130 11,100 14,200 24,400 18,700 1,101,000 335,000 774,000 18,500 2,541,430
We chose to use these two recognized search engines to evaluate trends in publications on CAM over the last 50 years. We found a large, consistent increase in the number of publications related to CAM over this period of time. The number of citations in PubMed increased over these 50 years more than twofold to 1.92 % of all citations. We did not find any previous paper in the medical literature that presented similar data. The classic papers that drew the attention of conventional medicine to CAM were published about 20 years ago. In 1993 Eisenberg published the results of a nationwide telephone survey in the United States, which showed that 34 % of the participants had utilized CAM in the previous year and that a third had visited a CAM practitioner [14]. There is an enormous economic potential in the field of CAM. In 1990, US residents made about 425 million visits to these practitioners, compared with 338 million visits to primary care physicians over the same period. The total expenditure by US residents for CAM for that year was estimated to be 13.7 billion dollars [15]. Recently, the process in which some of the CAM modalities have moved from a marginal position to the mainstream of medicine has led to an integration of healthcare systems. This change is especially salient in developed countries. With increased demand for CAM, there has been a shift toward integration between conventional medicine and CAM [16]. Over the last 50 years there has been large increase in the number of medical publications on CAM in general as well as on specific treatment modalities. The number of publications on CAM has grown in parallel to its development as a treatment modality. Modalities
that were previously almost unknown such as homeopathy, herbal medicine, and acupuncture are now appearing increasingly in medical publications. In contrast, there were already articles on hypnosis 50 years or more ago. Axel Munthe describes this treatment modality in the book “The Story of San Michele.” Over the years no increase in publications on this treatment has been seen in PubMed. In this study we did not assess individual papers, so articles that are not actually related to CAM may have been picked up by the search terms that we used. However, this potential bias should be the same for all time periods evaluated so it should not affect the trend of changes in the number of publications over time. We also did not look at the content of the articles so that it is possible that some of them do not prove the effectiveness of CAM or even show it to be ineffective. Yet, we believe that the data presented in this paper will contribute to existing knowledge on CAM. The effectiveness of various treatment modalities should be assessed so that the quality of medical care can be enhanced. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Research funding: None declared. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Treister-Goltzman and Peleg: Trends in publications on complementary and alternative medicine
References 1. Debas HT, Laxminaryan R, Straus SE. Complementary and alternative medicine. In: Jamison DT, Breman JG, Measham AR, et al. editors. Disease control priorities in developing countries, 2nd ed. Washington, DC: World Bank, 2006:1281. 2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a followup national survey. JAMA 1998;280:1569–75. 3. Shmueli A, Shuval J. Use of complementary and alternative medicine in Israel: 2000 vs. 1993. IMAJ 2004;6:3–8. 4. Jonas WB, Eisenberg D, Hufford D, Crawford C. The evolution of complementary and alternative medicine (CAM) in the USA over the last 20 years. Forsch Komplementmed 2013;20:65–72. 5. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports 2008:1–23. 6. Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine and frequency of visits to CAM practitioners: US, 2007. 2009, National Center for Health Statistics, Hyattsville, MA. 7. Giordano J, Boatwright D, Stapleton S, Huff L. Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice. J Altern Complement Med 2002;8:897–906.
115
8. Turner L, Galipeau J, Garritty C, Manheimer E, Vieland LS, Yazdi F, et al. An evaluation of epidemiological and reporting characteristics of complementary and alternative medicine (CAM) systematic reviews (SRs). PLoS One 2013;8:e53536. 9. Ni H, Simile C, Hardy AM. Utilization of complementary and alternative medicine by United States adults: results from the 1999 national health interview survey. Med Care 2002;40:353–8. 10. Herman PM, Poindexter BL, Witt CM, Eisenberg DM. Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ Open 2012;2:e001046. 11. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore 2009;5:277–89. 12. Ryan TJ. Integrative medicine selects best practice from public health and biomedicine. Indian J Dermatol 2013;58:132–41. 13. Wikipedia. PubMed. http://en.wikipedia.org/wiki/PubMed. Accessed 10/2013. 14. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246–52. 15. Gavaghan H. Koop may set up new centre for alternative medicine. Nature 1994;370:591. 16. Jong MC, van de Vijver L, Busch M, Fritsma J, Seldenrijk R. Integration of complementary and alternative medicine in primary care: what do patients want? Patient Educ Couns 2012;89:417–22.
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